Wilkie’s syndrome: review of eight cases / Wilkie’s syndrome: review of eight cases.

BACKGROUND: The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and abrupt weight loss. Usually seen in tall individual with low bod mass index (BMI), the weight loss may be primary or secondary to a systemic disease or to the syndrome itself Compression of the duodenum between the abdominal aorta and the superior mesenteric artery due to loss of the duodenal pad of fat causes the obstruction. Early recognition prevent complications. Imaging and endoscopy is diagnostic. Aorto-mesenteric angle and SMA aorta distance is lower than 22 degree and eight millimeter respectively. If nutritional support fails, surgery is required (e.g. guodeno-jejunostomy). Studies to determine the optimal methods of diagnosis and treatment, especially in a suburban hospitals with limited expertise are essential. CASE REPORT: We retrospectively evaluated 8 cases presented over three years. Six (75

) patients were males, age ranged from 19 to 70 years and weight from 40 to 55 kg. The mean BMI was 18.7 kg/ m2 (range 16.42 to 25.11 kg/m2). Mean weight loss before diagnosis was 9.88 kg (range 6 to 12 kg). Symptoms developed between 8 to 180 days (median 12 days). Commonest presentation was epigastric pain, vomiting and nausea. Four patients had pre-morbid conditions and the syndrome was idiopathic in the other 4. Median aorto-mesentric angle was 16.5 degree and SMA-aorta distance was 5.15 mm. Four patients required operation. The rest improved on conservative treatment. CONCLUSION: Early recognition, institution of the appropriate conservative measures and timely selection of a definite surgical method are critical to prevent severe complications and death.

Adrenal myelolipoma--report of a case.

Adrenal myelolipoma is a rare, benign, non-secreting tumour composed of adipose and haematopoietic tissue. One such rare case in a 32-year-old female who presented with'pain in right lumbar region is reported here. CT scan revealed a mass in the suparenal region measuring 5.6 x 5 cm. In view of the size and symptomatic nature of the mass, surgical resection was performed. Histological examination revealed the features of myelolipoma. The outcome was favourable without recurrence after a follow-up of one year.

Bilateral femoral hernia in male--a case report.

Femoral hernia is not a common entity in males and bilateral cases are reported rarely in literatures. Here a case of bilateral femoral hernia which was misdiagnosed as a simple bilateral inguinal hernia in a young male patient is reported. The patient was managed successfully by conventional low approach of Lockwood in the same sitting. He recovered uneventfully and discharged on 5th postoperative day. Laparoscopic technique of repair of femoral hernia is evolving and may replace conventional methods